RESUMEN
Venous system aneurysms appear relatively rarely, and are even more rarely diagnosed, especially if asymptomatic. In the material of our clinic we provide a variety of practices in three patients with venous aneurysms depending on the location, symptoms and main disease. In some patients the occurrence of pulmonary embolism is the first symptom of venous aneurysms, having influence on the selection of further diagnostics, conservative treatment, as well as on endovascular or operating procedure. The proper diagnosis of a venous aneurysm takes place in case of doubling or tripling of the diameter of the basic dimension of the lumen, often with the presence of thrombotic material. Asymptomatic venous aneurysms are usually detected during routine pre-operative diagnosis also including duplex-Doppler studies. In the presence of pulmonary embolism positive angio-CT and scintigraphy raise the suspicion of venous aneurysm unless any other reason is apparent. There is no standard treatment of venous aneurysms. This has to do with the relatively low epidemiology, diversity of location, difficulties in determining the proper primary and secondary aetiology, anatomy and coexisting diseases. Despite the many unknowns a few issues should be considered before appropriate treatment is undertaken. Undoubtedly, the shape itself, the location and size of the aneurysm with the presence or not of thrombotic material are of great value in evaluating the risk of complications, including possibly lethal pulmonary embolism, local symptoms of venous hypertension and possible complications of surgery. In this paper we present 3 patients treated for venous aneurysms located in different regions: popliteal vein, brachial vein and iliac internal vein.
Asunto(s)
Aneurisma/terapia , Venas Braquiocefálicas/patología , Vena Ilíaca/patología , Vena Poplítea/patología , Adulto , Aneurisma/diagnóstico , Aneurisma/etiología , Aneurisma/mortalidad , Diagnóstico Diferencial , Femenino , Foramen Oval Permeable/diagnóstico , Humanos , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Flebografía , Sistema Porta , Pronóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiología , Tasa de Supervivencia , Tomografía Computarizada por Rayos X , Ultrasonografía , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/etiología , Insuficiencia Venosa/terapia , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapiaRESUMEN
In case of changes occurring within the extracranial sections of the common and internal carotid artery the operative procedure has become a generally accepted surgical method. Another reason of brain ischemia is the vertebro-basilar insufficiency caused by external pressure on the vertebral artery in a channel formed by transverse processes of cervical vertebrae. The author presents the clinical experience with 54 cases that have been treated surgically from 1994 to 2003 due to the above mentioned reasons. In all patients an anastomosis between the distal vertebral artery and external carotid artery gave good or very good results.
Asunto(s)
Isquemia Encefálica/cirugía , Revascularización Cerebral/métodos , Insuficiencia Vertebrobasilar/cirugía , Adulto , Anciano , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Arteria Carótida Externa/cirugía , Cerebelo/irrigación sanguínea , Infarto Cerebral/diagnóstico , Infarto Cerebral/etiología , Infarto Cerebral/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Arteria Vertebral/cirugía , Insuficiencia Vertebrobasilar/diagnóstico , Insuficiencia Vertebrobasilar/etiologíaRESUMEN
BACKGROUND: Iatrogenic trauma of the carotid artery (CA) is a dangerous intraoperative complication, especially during oncological and endocrinological procedures. In these cases massive hemorrhage and severe neurological complications may occur. The outcome of reconstructive procedures is often fatal because of the long delay of surgery after the injuries occuring in non-vascular centers. PATIENTS AND METHODS: In this paper 22 cases of iatrogenic CA trauma will be presented, operated in the period of 1980-2003. Different methods of operation were performed according to the extent of trauma and anatomical changes. RESULTS: In spite of emergency help two patients died. In three cases cerebral stroke was observed. Additionally peripheral nervous damages were noted. CONCLUSIONS: Iatrogenic CA trauma is one of the most dangerous vascular injuries, connected with hemorrhage and neurological complications. We recommend intravenous administration of 5000 units unfractionated Heparin, anatomical artery preparation, then shunt inserting. Autogenous material should be used if possible. For reconstruction of the initial part of internal carotid artery the transposition of the external carotid artery is useful.
Asunto(s)
Traumatismos de las Arterias Carótidas/diagnóstico , Traumatismos de las Arterias Carótidas/cirugía , Servicios Médicos de Urgencia/métodos , Enfermedad Iatrogénica , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Adolescente , Adulto , Anastomosis Quirúrgica/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Carotid artery injuries reveal as a specific and relatively small group of vascular trauma. Hemorrhage from vessels of this diameter and flow (10 % of cardiac output) has predominantly a fatal end or shows severe neurological sequelae. Cut and stab wounds represent the majority of carotid injuries, often associated with venous damage. Blunt trauma and fractures of the skull basis are uncommon causes. We present 43 cases of carotid injuries operated upon as emergency service (in the majority outside of our hospital). The number of postoperative surgical and neurological complications was moderate.
Asunto(s)
Traumatismos de las Arterias Carótidas/cirugía , Arteria Carótida Interna/cirugía , Urgencias Médicas , Traumatismos Cerrados de la Cabeza/cirugía , Base del Cráneo/lesiones , Fracturas Craneales/cirugía , Heridas Punzantes/cirugía , Adolescente , Adulto , Anciano , Traumatismos de las Arterias Carótidas/mortalidad , Femenino , Estudios de Seguimiento , Traumatismos Cerrados de la Cabeza/mortalidad , Humanos , Enfermedad Iatrogénica , Complicaciones Intraoperatorias/mortalidad , Complicaciones Intraoperatorias/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Reoperación , Base del Cráneo/cirugía , Fracturas Craneales/mortalidad , Heridas Punzantes/mortalidadRESUMEN
Buttock claudication is rather rare symptom of atherosclerosis. Authors presented a case of 61 year old patient in whom buttock claudication was only one symptom. The patient was surgically treated (endarterectomy of iliac internal artery with ilico-femoral bypass) with excellent result. Authors pointed out necessity of restoration of blood flow through internal iliac artery as a prevention or treatment in buttock claudication.
Asunto(s)
Arteriosclerosis/diagnóstico , Claudicación Intermitente/diagnóstico , Pierna , Arteriosclerosis/cirugía , Endarterectomía/métodos , Humanos , Arteria Ilíaca/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Indications for surgery of vertebro-basilar insufficiency are: stenosis or occlusion due to atherosclerosis. The initial parts of carotid, subclavian arteries or brachiocephalic trunk one must frequent involved. From the other hand arterial compression on vertebral arteries (diskopathies or osteopathies) leads to symptoms of cerebral ischaemia. In diagnosis very important are history of disease, physical examination and neurologic assessment. Additional procedures consisted of: color Doppler-scan, transcranial Doppler, cerebral CT-scan and angiography. By-pass of stenotic or occlusive segment of artery is procedure of choice in this disease.